Posts Tagged ‘Patient Protection and Affordable Care Act’

Waiting for 2014: One Family’s Story

Thursday, August 23rd, 2012

When Joshua Lemacks of Richmond, Virginia takes the field for one of his Little League games, the other team may not be overly impressed with his batting average stats, but those who know him realize that he has beaten extreme odds just to be standing on that field with his teammates.  What the other team doesn’t know is that if Joshua and his parents hadn’t batted 1000 in his early years, he wouldn’t be alive today.

Nine years ago, soon after Joshua was born, a fetal cardiologist came into the room with a box of tissues and told his parents that their newborn’s heart defect was 100% fatal. Later, the cardiologist offered them somewhat better odds if Joshua underwent three high-risk surgeries, one right after delivery.  His odds of surviving the first surgery were about 5 percent. Joshua’s parents, Jodi and Mark, opted for the surgeries because they wanted to give their baby the best chance they could.  Even though they were insured, they incurred monumental out of pocket costs.

Today, Joshua has not only beaten those odds, he is thriving. “He’s as healthy as a horse,” Jodi says. He plays baseball and golf and is a very happy child who seems like any other active little boy except for the scar on his chest and the medical bills that have piled up for his family.

Even when Josh is healthy, the family’s medical bills add up. Josh has, effectively, “half a heart,” as Jodi puts it, and with today’s technology, his defect cannot be “fixed.” He needs regular check-ups, but he also needs to see a cardiologist at least once a year and undergo expensive testing.  Also, while he doesn’t get sick more often than other children, normal childhood illnesses hit him harder than they do others because his heart can’t work as effectively.  Jodi estimates their health care expenses to be as much as $17,000 in out-of-pocket costs, including premiums, in good years when Josh is relatively healthy. This is a substantial portion of their family income. Even though it’s comprehensive medical insurance, the premiums and co-payments required to obtain needed medical care are prohibitive.

This affects not only Josh but the whole family. When Josh’s older brother hurt his arm in an accident during a family trip to New Orleans, they debated going to the emergency room for x-rays because of the cost. They did take him – he’s their son, after all – but, just as they feared, they got “nailed with bills” because their plan only covered a fraction of the cost.

“I feel trapped” in this health insurance policy, Jodi says. Even though she has a better, more generous group plan through her job at a national non-profit, Jodi is afraid to move her kids and husband onto it. Why? Because when the family enrolled in their current policy, Joshua hadn’t been born yet. And he hadn’t yet had his diagnosis of hypoplastic left heart syndrome. As a result, the insurance company’s underwriters assigned him the healthiest possible risk category – a “1” in insurance terms. As high as they are, their premiums are set as if Joshua were a “normal,” healthy child.

But that would not be true if they were looking for a new individual policy on the market today. An insurance underwriter would take one look at Josh’s medical history and run in the other direction. If the family obtains a new policy that includes Joshua, they can expect to pay high rates because of Joshua’s illness– as much as $3100 per month in Virginia, their home state. So Jodi is afraid to move him off their current policy and onto her group plan. If she were to lose her job-based insurance for any reason, they almost certainly could never find an affordable new policy for Joshua.

Because of Joshua’s condition, he will inevitably need long-term monitoring and care. His heart problem cannot be “fixed.”  Kids with this problem may develop arrhythmias, may need a pacemaker, and can develop liver disease, among other complications. Because the oldest person with this condition is only in his 30s, no one really knows what the life-expectancy is, but we do know care over their lifetime will be costly.

With the Affordable Care Act comes new hope for Joshua and his parents. Beginning January 1, 2014, insurance companies will no longer be allowed to charge more to cover Joshua because of his heart condition. The family will pay the same premiums as a family without any health problems.

And Jodi is looking forward to the new state-based marketplaces called insurance exchanges, which will, for the first time, offer web-based tools so she can make apples-to-apples comparisons among different health plan options to select a plan that has the doctors and care Joshua needs.

We asked Jodi what it would mean for her to have guaranteed access to policies in which Joshua couldn’t be discriminated against based on his health status, and an exchange where she could compare her options. She responded: “That gives me choices. I also think it will be more competitive. Right now I’m stuck. I don’t like our current policy, but I can’t move Joshua anywhere else. But if I can compare plans on an exchange, maybe there is one out there that covers a bit more of what we need. That would give me the freedom to choose it.”

In addition, because the family’s income is less than 400% of the federal poverty level, they are likely to qualify for the ACA’s tax credits to help defray the cost of their insurance premiums. In addition, health plans will be required to cover a comprehensive set of benefits and limit families’ out-of-pocket costs.

Jodi imagines a future for Joshua under the ACA in which he can embark on a career that matches his skills and passions, secure in the knowledge he can get the health coverage he needs. He won’t have to choose a job just because it offers a good health plan. “He can start out of college…and he’ll have choices,” she says. “He is such an amazing child, and we love him so much. Like any parent, we want the absolute best for him.”

Thanks to the support of the Robert Wood Johnson Foundation, the AHA is proud to be a part of the Georgetown University Health Policy Institute’s “Real Stories, Real Reforms” project.  You can read more profiles of everyday people across the country who will – or have already – benefited from new consumer protections under the Affordable Care Act on the CHIRblog .  This post – about Joshua and his family – marks the first story in the series.  We hope you’ll follow future stories about the impact of the Affordable Care Act.

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Nearly 50,000 with Pre-Existing Conditions Covered Under Health Reform Law

Thursday, February 23rd, 2012

The Department of Health and Human Services (HHS) released a new report today finding that the Pre-Exisiting Condition Insurance Plans (PCIP) created under the Affordable Care Act will enroll close to 50,000 people. These PCIPs help those Americans who are barred from private insurance do to a pre-existing condition and who don’t qualify for public programs, like Medicare and Medicaid.

“For too long, Americans with pre-existing conditions were locked out of the health care system and their health suffered. Thanks to health reform, our most vulnerable Americans across the country have the care they need,” said HHS Secretary Kathleen Sebelius.

In 2014, insurers will not be allowed to refuse coverage do a pre-exisiting coverage, but these PCIPs fill-in the gap until that year. All 50 states have these plans in place for their residents.

Click here to read the full statement by HHS.

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AHA Files Joint Amicus Brief to Supreme Court

Thursday, January 12th, 2012

The nation’s leading groups representing patients and families living with cancer, diabetes, heart disease or stroke jointly filed an amicus brief with the U.S. Supreme Court today in support of provisions of the Affordable Care Act that are critical for people with life-threatening chronic diseases.

The American Cancer Society, the American Cancer Society Cancer Action Network, the American Diabetes Association and the American Heart Association filed an amicus curiae in the appeal of a decision handed down by the U.S. Court of Appeals for the 11th Circuit, in Atlanta. The decision, from a divided three-judge panel, said the “individual responsibility” or “individual mandate” requirement that most Americans purchase insurance coverage was unconstitutional, but found that the remaining parts of the law could remain in force.

Read their joint statement and gain access the amicus brief.

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Make a Call for Prevention Today!

Thursday, December 15th, 2011

If we invested just $10 a person each year in community health programs, our country would save $16 billion a year – while still providing quality health care. Those are some big savings! That’s why we need your help to tell Congress to keep investing in public health through the Prevention and Public Health Fund.

The Prevention Fund was recently established to empower individuals and communities with the tools and resources they need to help prevent heart disease, stroke, obesity, and tobacco use. But now it is in jeopardy as Congress looks to make spending cuts. Tell your elected officials, “Don’t make cuts to the Prevention Fund” by calling them today.

Calling your elected officials is fast and painless, and today you’ll be joining with thousands of people who are speaking out. We are partnering with dozens of other public health organizations to defend the Prevention Fund by calling lawmakers today. Here’s how to make your call:

1. Before the end of the day, call your legislators by connecting to the Capitol Switchboard at 202-224-3121. Don’t know your legislators? Click here  and use our Legislator Look-Up tool to find out.

2. A staff person will answer the phone. It’s their job to take calls from constituents, so don’t be shy! Tell that person your name, where you’re calling from, and that you are counting on the Member to support the Prevention Fund, which will save American lives by helping prevent heart disease and stroke.

3. Many calls end here. However, if you like, you can add that he/she should support the fund because:

• The U.S. needs to invest in prevention in order to get health care costs and the budget under control. For example, the combination of cardiovascular disease (CVD), cancer, and diabetes costs the U.S. an additional $1 trillion in lost productivity each year.

• The Fund supports effective, proven prevention programs aimed at reducing chronic illnesses, such as childhood obesity prevention and tobacco cessation.

4. Once you’ve ended your call, click here to tell us how it went!

Congressional staffers are there to take your calls and keep tabs on what constituents care about to inform the decisions of our nation’s leaders. Your quick call will make a big difference.

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5 Facts You Probably Didn’t Know About the Prevention and Public Health Fund

Monday, December 5th, 2011

1) The Fund was established under the Affordable Care Act to implement state and local programs to help improve health, reduce health disparities, and lower health care costs.

2) It represents an unprecedented investment- $15 billion over 10 years- that will help prevent chronic diseases, including heart disease and stroke.

3) People in all 50 states and DC benefit from the fund.

4) Prevention funding is a wise investment in our future. A report from Trust for America’s Health concluded that investing $10 per person, per year in proven, community-based programs that increase physical activity, improve nutrition, and prevent smoking could save the country more than $16 billion annually within 5 years.

5) Serious threats to the Fund exist as Congress looks for spending cuts, so health advocacy groups, like the AHA, are urging our nation’s leaders keep chronic disease prevention as a priority.

Learn more about how the Fund improves wellness and prevention for your state- and stay tuned for opportunities to help protect this important investment in our nation’s health.

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Help Us Protect Consumers’ Health Care Rights

Friday, November 18th, 2011

Complex information. Confusing lingo. Details hidden in the fine print. For most Americans, choosing a health care plan is very difficult. As a result, some patients find themselves with insurance plans that do not provide the coverage they need when they need it most.

Luckily, one of the many consumer-friendly provisions in the Affordable Care Act requires that beginning next year health insurance companies must clearly, simply, uniformly detail what each plans covers and how much it costs. This will make choosing health insurance plans easier for millions of Americans.

Unfortunately, special interests in Washington are trying to stop the implementation of this vital tool which would give all Americans the vital information that they need to make the right health care choices for them and their families.

We need to tell the Administration to continue implementing this vital aspect of  health reform. Please take a minute and let your voice be heard!

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National Patient Groups Welcome Supreme Court Announcement to Review Affordable Care Act

Monday, November 14th, 2011

Statement of the American Cancer Society, American Cancer Society Cancer Action Network, American Diabetes Association and American Heart Association

WASHINGTON – November 14, 2011 – The nation’s leading groups representing patients and families living with cancer, diabetes, heart disease or stroke issued the following statement today in response to the announcement that the U.S. Supreme Court will consider the constitutionality of the Affordable Care Act.

The American Cancer Society, American Cancer Society Cancer Action Network, American Diabetes Association and American Heart Association filed as amici curiae in multiple federal courts of appeal in support of the constitutionality of the law.

Following is a statement from the four organizations that filed the amicus brief:

“Our organizations, which represent tens of millions of people across the country who are living with cancer, diabetes, heart disease or stroke, welcome the Court’s announcement and hope that it will uphold the constitutionality of the Affordable Care Act to ensure that patients with life-threatening chronic diseases can access the law’s critical protections.

“Our organizations believe that patient protections, including those that end discrimination in the insurance market against people with pre-existing conditions, rely on the individual responsibility requirement. These provisions significantly improve the health care system for chronic disease patients and their families by expanding access to quality, affordable health care; reducing the cost burden on families; and refocusing the system to emphasize prevention.

“For decades our organizations have worked to expand access to health care nationwide and to boost our nation’s emphasis on disease prevention and management. As any patient knows, chronic disease strikes people without regard for their opinions or political persuasion. We are optimistic that timely review by the nation’s highest court will help to mitigate confusion and allow implementation to continue in a way that supports and strengthens provisions of the law that enable patients with chronic diseases to access quality, affordable health care.”

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New Heart-Healthy Benefits in Medicare

Friday, November 11th, 2011

Medicare just made it easier for those over 65 to live heart-healthy! On Thursday, November 11, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare will offer more free preventative services that aim to help reduce the risk of heart disease and stroke.  These new benefits are in addition to the many free prevention services established under the Affordable Care Act and are crucial to ensure that our seniors will live well into their golden years. 

Specifically, those in Medicare can receive a yearly in-person meeting with a qualifying primary care practitioner to talk about heart disease and stroke prevention, get screened for hypertension, and discuss healthy eating habits. Read more about the new benefit and see if you or a loved one qualifies for the valuable service. 

This new benefit is a part of the Million Hearts initiative that the U.S. Department of Health and Human Services announced in conjunction with CMS and the Centers for Disease Control. The American Heart Association is a proud partner of the Million Hearts initiative and supports its goal of preventing a million heart attacks and strokes by 2017. To find out more information, visit the Million Hearts website

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Health Care and You- 2011 Affordable Care Act Recap Web Chat

Saturday, November 5th, 2011

It has been a busy year for the health care law and its implementation. Join the Health Care and You Coalition on Thursday, November 17, 2011 at 1:00 p.m. EDT for an interactive chat to review the parts of the law that have taken effect, including changes in Medicare prescription drug coverage, coverage for people with pre-existing conditions, and new requirements on how insurers spend your health care dollars.

The health care law will continue to be rolled out over the next few years, so make sure you are staying up to date on what it means for you by joining the chat!  Send in your questions now and then participate on 11/7 by visiting

The American Heart Association is a proud member of Health Care and You, a coalition aimed at providing the public with easy-to-understand information about the health care law. 

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Are you ready for September 23rd?

Monday, September 20th, 2010

September 23rd marks the six-month anniversary of the Affordable Care Act being signed into law- and for the 81 million Americans living with heart disease or stroke, and the millions more at risk, it is definitely a date to take note of. That’s because a number of new health care protections, which will help improve patients’ access to affordable care, will take effect that day.

Do you know what this means for you?

If not, you’re not alone. That’s why the American Heart Association is here as a resource for patients and their families. As an informed consumer, it is critical for you to understand what’s changing and what options are available to you in order to access and afford the quality care you need and deserve.

By visiting our website,, you will find:

1. Information about the patients protections taking effect this week, such as:

- Eliminating lifetime caps on coverage and restricting annual limits

- Prohibiting coverage denials to children based on pre-existing conditions

- Allowing young adults (under age 26) to remain covered under their parent’s plan

- Providing preventative services for free under new health plans (and in Medicare starting January 1)

- Prohibiting insurance companies from rescinding coverage if you get sick

2. A series of short videos featuring AHA experts who answer your fellow volunteers’ questions about the health care law and the new protections mentioned above.

3. Links to other resources to provide you with additional information and tools to learn about the protections and options available to you.

The American Heart Association has long recognized that ensuring patients have access to the care they need is critical to our mission of building healthier lives free of cardiovascular disease and stroke. We hope you will seek out the information you need to learn about how the new law will affect you, so you can take full advantage of these new consumer provisions and patient protections.

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